From May 2007 to July 2009, the author used needle knife to treat 100 cases of nocturnal chest and back pain, and the therapeutic effect was satisfactory. Clinical data: 31 men and 69 women in 100 cases; age 16-72 years old, average 37.8 years old; disease duration 2d-6 years. The pain was most common in the middle part of the chest and back (T5-T8), followed by the lower part, and was rare in the upper part of the chest and back. Symptoms and signs: nocturnal chest and back pain, mild chest and back pain in the second half of the night or at dawn or waking up from a dream, chest and back pain is aggravated by stretching, lateral flexion pain can be temporarily alleviated, the pain is rapidly relieved after getting up and there is no discomfort in the daytime, while in severe cases, the chest and back pain starts soon after lying down and intensifies rapidly, forcing the patients to change the sleep position constantly, and the pain is alleviated for a while after changing the sleep position, and the patients tend to go to sleep for 1-2h and are woken up by the pain. The patients often fall asleep for 1-2h and are awakened by the pain, which is often accompanied by chest tightness, shortness of breath and back stiffness and discomfort, and the pain is gradually relieved after waking up. X-ray examination showed no obvious abnormality, but patients with advanced age and long course of the disease could see vertebral anterior and posterior margins of different degrees of osteophytes, osteoporosis, corresponding intervertebral space stenosis, CT and ultrasonography ruled out the liver, gallbladder, pancreas and other internal organs, and rheumatology 4 tests showed rapid blood sedimentation, CRP and RF were weakly positive in some of the patients. Treatment method The patient was lying down, in the diseased thoracic vertebral segments, the spinous process connecting the line next to the opening of 0.5-1.5cm range of positive reaction points (pressure and pain points, hard nodules), if there is no obvious positive points, then select the diseased thoracic vertebral segments, spinous process on both sides of the interspace next to the opening of about 1.0cm for the needle point, generally take 2-8 points, we choose the Hanzhang brand of disposable I-type No. 3 small needle, according to the four-step procedure of needle needle knife closed surgery[1]. Stab vertically into the subcutaneous, slowly deep, cut the hard knot, cut off the hard cord, cut the small joint capsule, peeling, loosening the adhesion, tension of the soft tissues, straight to the bone surface, feel the loosening of the knife can be out of the needle. Before positioning, we should pay attention to whether there is lateral curvature and rotational deformity of the thoracic spine in combination with X-ray film, and grasp the depth and angle of the needle and knife in the tissues during the operation, so as to avoid accidental entry into the spinal canal and the thoracic cavity. After the treatment, the patients were placed in supine position with a thin pillow for 30 minutes, and the treatment was performed once every 5 days. Criteria for efficacy Cure: pain disappeared, thoracic spine activity is normal; obvious effect: pain disappeared, occasional discomfort in the chest and back after exertion; effective: pain relieved, pain aggravated after exertion, can be relieved by rest. Results of treatment In this group of 100 patients, 48 cases were cured once, 22 cases were cured twice, and after 1-5 times of treatment, 86 cases were cured, 10 cases were obvious effect, and 4 cases were effective according to the above standard. All the patients were followed up for half a year, but 6 patients were relapsed due to overwork or cold, and were treated with needle knife again. Discussion Nocturnal chest and back pain belongs to the category of “paralysis” in traditional Chinese medicine, which is mostly caused by the weakening of yang qi in the vegetative body, the emptiness of the directing vein, or the invasion of wind, cold and dampness into the solar meridian in the back. The disease is common in young and middle-aged people who have been standing for a long time and engaged in stooping activities for a long time. Thoracic spine is convex, frontal joint surface and the presence of the thorax, limiting the thoracic spine flexion and extension movements, allowing only a little flexion and extension, the thoracic spine discs are very thin, the joint capsule is more tense [2.3.4], in the thoracic spine in forward flexion, in order to maintain the stability of the spinal column, the small joint capsule and periarticular soft tissues to bear a greater tension. Low head flexion, prolonged standing, prolonged sitting and stooping, the soft tissues of the thoracic back are subjected to acute or chronic injuries, resulting in aseptic inflammation, stagnation of qi and blood, and loss of nourishment of the tendons and veins, which may lead to the formation of soft tissue adhesions, scars, fibrotic sclerosis, and hypertrophy of the capsule of the lesser joints. The spine and the sun meridian for the dukedom and over, with the main yang qi, during the day, the human body yang qi stretch, qi and blood flow, pain or pain light, night yang qi convergence, the human body qi and blood run slower, with the local inflammatory metabolites continue to accumulate, the pressure in the tissues more and more, the pain is gradually aggravated, get up to move, yang qi outside the open, the blood circulation to speed up the metabolites are absorbed, the pressure reduces, and the symptom is also relieved. The causes of pain caused by soft tissue lesions are mainly acute and chronic injuries and aseptic inflammation of soft tissues caused by wind, cold and wet factors, and the mechanisms are as follows: aseptic inflammation, the release of nociceptive chemicals and increased tissue pressure on the stimulation of its injury receptors; scarring of soft tissues, fibrosis on the sensory nerves embedded in the pressure; lesions of soft tissues on the neighboring nerves of the direct pressure and aseptic inflammation of the adjacent nerve direct stimulation [5]. direct stimulation of nerves [5]. On the one hand, needle knife treatment can directly penetrate into the lesion to peel off adhesions and scars, cut and shred fibrotic and hardened soft tissues, cut off spastic and tense muscle fibers, improve the local blood circulation, reduce the pressure in the local tissues, relieve muscle spasm, and eliminate sterile inflammation, and on the other hand, it is also a kind of mechanical stimulation, and according to the principles of bioelectricity and piezoelectricity, in the lesion area, the mechanical energy will be converted into thermal energy, which will make small blood vessels dilate and strengthen the local lesion. According to the principle of bioelectricity and piezoelectricity, in the lesion area, mechanical energy will be converted into thermal energy, which will make small blood vessels dilate and strengthen the nutritional supply of the local lesion tissues, and the strong stimulation of the mechanical nerve endings can make the local tissues and organs enhance the mobility and accelerate the blood-lymphatic circulation to improve the metabolism of the local tissues [6]. We use the needle knife to cut and loosen the lesion, peel off the adhesion, dredge the blockage, can eliminate the aseptic inflammation, release the nerve compression and stimulation, so that the yin and blood full, the guest cold removed, yang qi vibration, meridians through the pain since the elimination. Because of the lack of obvious positive signs in patients with nocturnal chest and back pain, the diagnosis is not very clear, there are myofascial pain syndrome, fibromyalgia syndrome, posterior thoracic spine joint disorders and so on, in the clinic, we found that the thoracic small joint capsule as the main thoracic spine edge of the combined injury lesions of a variety of soft tissues for the main cause of the disease, diagnosis of soft tissue injury pain is more appropriate.